A woman and man talking

When is it okay to lie to somebody with dementia?

Tim Beanland, Head of Knowledge Management at Alzheimer's Society, discusses the difficult choices and situations around lying to a person with dementia to protect their feelings.

I try not to lie, honestly, but some things push the boundaries: “Socks! You shouldn’t have”; “No, I'd love to have your mother visit” and – often to my subsequent regret – “But I've only had one drink all evening”. Being a bit flexible with the truth is just part of the social contract isn't it, the price we pay for jogging along in relative peace? 

But what if one of us has dementia? What price comes with telling the truth then?

Types of questions a person with dementia might ask

The questions people living with dementia ask can challenge us. You may recognise some of these from your own experience:

  • When is dad coming to visit? (When the person’s father is sadly long dead)
  • Will I be going home soon? (Person living in a nursing home)
  • Shall I set the table for the guests? (From a former B&B owner, now in residential care)
  • You seem nice to me... but who are you? (Person to their partner)
  • Why have you stolen my purse? (Person living in the community)
  • Who are those little people by the window? (Person could be living anywhere)

For those close to people with dementia, how to respond can be a daily challenge. Is it acceptable to lie – ever? Or should we just tell the brutal truth - always?

How we respond will affect how the person and us feel and behave, now and in the future. If we get things wrong we can erode the foundations of a relationship which may well be already strained. 

Why might a person with dementia ask difficult questions?

The Society contributed to a 2016 report by the Mental Health Foundation which addressed this topic. A key conclusion was that these kinds of questions often arise when the person is living in a different reality and/or has different beliefs from those around them.

These differences may become more apparent as dementia progresses but they are not limited to the condition’s later stages. They include:

  • behaving as if a younger version of themselves (time shifted)
  • beliefs – sometimes strongly held – that are false to others (delusions)
  • unfounded suspicions or allegations about others (infidelity, malice, deceit)
  • seeing things that aren’t there (visual hallucinations).

We need to understand that these realities and beliefs often have meaning for the person with dementia, and we should not simply belittle or dismiss them.

Rather, as with changes in behaviour, the challenge when supporting someone is to get behind the words, rather than attribute them as simply dementia ‘symptoms’.  (Hallucinations in dementia with Lewy bodies may be an exception, because they can be simply a symptom.)

For example, if someone with dementia asks for their dad, they may be expressing a need for comfort which is not being met. If someone says they are setting the table for 'guests', maybe it's because they are using older, more familiar memories to make sense of the present. When someone with dementia invents a story, it may be a coping strategy to support self-esteem.

Truth and lying are not absolute

One of the strengths of the report was recognising that 'truth' and 'lies' are not as simple as black and white.

A spectrum runs from ‘Whole-truth telling’ through ‘Looking for alternative meaning’, to ‘Distracting’, ‘Going along with’ and finally ‘Lying’.

As we move through this sequence the level of deception rises and we feel less at ease; who likes lying to a loved one?

It feels uncontroversial that we would all want our default response setting to be telling the whole truth. But it is equally obvious that the whole truth can sometimes be a ‘brutal’ truth. Who would support telling the whole truth when a person repeatedly asks after a long-dead parent as if the parent were still alive?

The whole truth here could mean repeatedly breaking the news of the parent’s death as if afresh every time. What could be more cruel?

Selecting the correct response to reduce distress

We instinctively want to be towards the ‘whole-truth’ end of the spectrum, but we also want to minimise any distress our response causes to the person with dementia. But these aims often contradict, leaving us to seek a balancing act or a ‘least-bad’ trade-off. (We should not forget our own wellbeing either, as we don’t want to end up feeling bad with ourselves.)

One consequence of this approach is that it supports a direct lie only if to do everything else would cause the person significant physical or psychological harm. Professionals sometimes call this a ‘therapeutic lie’, but it needs to be seen a bit like antipsychotic drugs: use only under very selected conditions and then with care.

It’s also really important to recognise how hard this balancing act can be, particularly if the person’s realities/beliefs fluctuate – for example, they are time-shifted only some of the time. Carers can often be unfairly accused, find that their own reality is being suppressed, or feel unnecessarily guilty if they occasionally get their response ‘wrong’. 

Responding to difficult questions from a person with dementia

Although every case needs taking individually, some guiding principles to start with include:

  • be compassionate 
  • try to understand and acknowledge the person’s feelings
  • seek to reduce distress and promote wellbeing or happiness.

When someone thinks you have stolen from them

Let’s take the ‘stolen’ purse example, on the assumption that the person’s suspicion is unfounded and they’ve simply mislaid it and forgotten where. Perhaps this has happened before and when you found the lost purse you returned it with a whole truth: ‘I didn’t steal it; I found it in a drawer where you put it’. 

If this approach has caused an argument or distress, It may be better to try something less blunt next time: ‘Sorry it took a while but it’s here: it was hiding upstairs’. If it’s a common accusation, trial and error like this seems a common-sense approach.

When someone asks about a deceased love one

If you think the person needs comfort or assurance, then ‘Is there something you wanted to ask them?’ might work.

The person with dementia may just want to reminisce about their partner, you could try saying something like, ‘I can tell you really cared for each other – tell me about them’, perhaps reinforced with personal photos, letters or objects.  As so often for someone with dementia, listening may be better than talking.  

Or it may be that the person with dementia is still grieving, in which case gently acknowledging that their partner has died and supporting them to grieve might be best – for example by talking about their relationship and the person’s life. 

But if the question here is frequent and the grief severe, then the humane response is likely to be to acknowledge the person’s feelings and gently move them on to a topic or activity that you know they will enjoy. This is clearly ‘distraction’ but it should still not deny or ignore their feelings.

Get support and advice

This blog post covers a lot of difficult issues. If you'd like further help or advice you can call the Alzheimer’s Society Support Line on 0333 150 3456.

To see how others have dealt with these issues, and share your own tips, visit our online community.

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62 comments

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On the term ‘therapeutic lie’. I remember spending time with a live-in professional carer. She talked about using ‘love lies’. I thought that this was an interesting way to phrase and rationalise the concept of therapeutic lies.

I really like the idea of ‘love lies’ it emphasises that the lie is told through caring.

I find it difficult sometimes what to do for the best when mum who has dementia thinks I'm her husband and wants to know when I'm coming home. She also gets flustered and panicky whenever she can't find something. One evening last week she rang more than 30 times but after the first few occasions I didn't bother answering. Is this wrong?

I'm not an expert but I think what the article reflects is that there is no right and wrong in these situations. It sounds as if you didn't answer the phone after the first few times because you needed some space after doing what you could to try to support her. It's important to pay attention to your emotional needs, as this will help to prevent burnout and help you to keep supporting your mum in the longer term.

Why would we subject our loved ones to additional angst and distress by being brutally honest. Surely we owe it to them to protect them from harsh and unwarranted facts, their emotional well being must always be paramount. Please common sense must prevail.

I clearly remember my first 'encounter' with Dementia. I was in hospital myself with a facial injury and concussion and there was a lady opposite me in the ward, on her own and clearly distressed. Having gone over to talk to her, I quickly became aware that something was not right ( I was not educated on Dementia at the time - that was my prompt to learn about it). I was trying to offer her some sort of 'comfort' in a distressing situation (hospital), despite, by this time having been told 'you won't get anywhere with her, she has Dementia'. But she did start to feel more at ease and then started telling me that we were on a coach trip to the seaside and were staying in a hotel. She was worried as she had forgotten her beach towel and little things like that. I did not want to plunge her back into distress with the harsh reality of the situation so I went along with her narrative and it calmed her distress.
Did I do right? I did not understand Dementia at that time but even with what I know now, I would say yes. How could I have swapped her pleasant trip to the seaside for the cold reality of hospital?
I do not know what happened beyond that as I was discharged before her.

My husband likes to go see his friends at the town bar. But when he stars drinking he drinks them like they are water and does not know when to stop. He thinks he only had one or two drinks. Anyone else have this problem?

Yes my husband does the same and always swears that he has only had two pints all night even though he has been out all night

My mum used to like a glass of wine on a Friday and Saturday night. Unfortunately with dementia, she thought every night was Friday and couldn’t remember how many glasses she had drunk. We tried hiding the wine but she just bought more... so we siphoned it off and replaced it with non-alcoholic juice. After a few months she forgot about the ‘wine’ altogether.

My Dad does the same. I have spoken to the bartender when we arrive in the pub and asked to replace 3/4 of the pint with non alcoholic beer. As his taste buds have changed this still tastes good. You could ask his friends to help in this. I suppose it is another ‘love lie’ but it means he can enjoy a drink socially without the after effects.

I cared for my wife for 9yrs and I admit telling a few porkies in that time. My wife frequently asked " when are children coming" really meaning the grand-children. It took a few minites but she never
forgot who I was.

Reality orientation always seemed cruel when I was nurse training in the 80’s and now having lived with loved ones with this awful disease I think theraputic lies necessary.

I am prepared to defend a big lie. My 86 year old mother has had Alzheimer`s Disease for 4 years. As far as she is concerned,she has age related memory loss. I and my sister have Power of Attorney of her finances and her health. We made sure her affairs are in order,and make sure all professionals are aware that we do not use words like Dementia. We feel we have protected her and kept her spirits up by doing this.

I found the previous comments very understanding and helpful. My partner has mid stage Alzheimer's.

I just wanted to say how really useful I found this article. Thank you

My wife has mid stage Alzheimer’s and I do lie quite often. We may be passing a place we have never been and she will often comment about being there in the past and I just go along with it. I do this every time. It stops her becoming agitated.

My Mum frequently tells of places that she has been and we know she hasn't but we just smile and say really. I only ever contradict her if I absolutely have to. There is no need to make her feel bad.

I had to have my mother's very much loved dog put to sleep as she was suffering badly from kidney disease. I chose the time when my mum was in hospital for a few days as by then, her dementia was so advanced that she would repeatedly ask the same questions. There was no way that I could break the news to my mum about her dog as every time the question 'where's Jenny?' would be asked, neither her carers or myself could inflict such cruelty on my mum and tell her she was dead. So we agreed a story: if my mum asked at night, the answer was 'Jenny's staying with Val tonight' and in the day, 'Ellen (her friend in the village) has taken her out for a walk.' It worked perfectly and my mum was happy with either answer. What could possibly have been gained by telling her the truth? I only found out about these 'love lies' through reading a book where a son's father kept asking where his wife was. The son kept saying 'but she's dead, dad.' Father was utterly distraught until the son changed his response to 'she's in Paris for the weekend dad.' Dad would then smile with delight and say' oh, she loves France, I'm so happy, she must be having a lovely time.'

I worked as live-in carer for a 92-year old gentleman who sometimes at meal times asked the whereabouts of his (deceased) brother. His wife's approach was to calmly and rationally explain to him that his brother had sadly passed away. And every time he reacted to the news as if it was the first time he was being told about it. Imagine going through the news of a loved one's death again and again. He would then doubt it - "surely I would remember my own brother's passing?" - and feel bad and confused over it until it eventually slipped away from his mind again.

Sadly my Gran suffered with dementia prior to her passing in 2015. Looking at the scale from truth to lying I can recognize various situations when we did all of this. For example, she consistently asked us when she was going home or why my mother (who was suffering with breast cancer) was poorly. We tried to be truthful to start with but quickly realized that it was causing more distress. It soon became apparent that distracting or lying was better for her wellbeing than being bluntly truthful. It does create a moral dilemma though - do you make them feel better but lie or do you tell them the truth knowing it will cause distress? At the beginning of the dementia journey with my Gran we used to challenge smaller issues we had like if she tried accusing someone or got confused about where someone was or what their name was. However, as it got worse, even the smallest issue caused a lot of distress and it soon was best for her wellbeing that we just distracted her from the issue or lied. It is an interesting dilemma though.

Best advice in my opinion on dealing with dementia came in five words from Maureen Reagan, whose father former President Reagan developed Alzheimer’s. She said simply: “You go where they are.” And yes, having had a brother who died from Alzheimer’s, I know the truth of this remark. Of course you don’t try to inflict reality on them. Loving lies are allowed! Read the helpful “Contented Dementia” by Oliver James.

As a friend of a 91 year old living with alzheimers I often 'go along' with where she is at - it is much simpler for me and also more compassionate a response.
As she lives in a residential home but always wants to 'go home' I simply say "You are having your tea here today and staying the night here too, you will enjoy that"...…..we cope with the short term, the here and now.

What a lovely thing to say, 'love lies'. Of course you will tell porkies if that will ease the distress of your loved one. Common sense tells you that disturbing and making sad the one you love is simply not the thing to do.

My Husband has started to say
How much are the flights back to the Uk (we are in Spain)
I said I do not know darling, why. ?
He said our parents are knocking on a bit now, I think we should go and see them before it's to late.
(Our parents passed many years ago.)
I said ok I will look into it and see what we can do.
He was pleased with this and started chatting about something else. Bless him
I would not distress him by telling him his mum & dad are no longer with us.
I don't feel guilty telling a Love Lie
My husband is stage 4-5
Mary x

Beautiful Mary, reads like a poem. I care for my husband and have to manage our lives with what I don't tell him as it then cannot cause him stress - that's a form of "love lie" and I couldn't care for him and look after me without it. Bless you. Debbie x

Here here to you Mary & Debbie. I trained as a student nurse in mid 70s 1973 to 1976yrs. Thank fully new care attitudes are coming in . My mum had sclerotic dementia & it was tough. Her tears, tantrums all hours of day & night then put in a nursing home as I'd become disabled & step dad couldnt cope. During the day I'd send him down to his local. If night make him use spare bed anything to stop him arguing with her & frequently she was right . It's no use arguing with a dementia person & they are still your loved one . Life perspective has changed. Keep things as simple as possible .

As a nurse in elder are, the sensible thing to do is to reaffirm the demented person’s reality in the most positive manner—depending on their grasp of reality, ask”why do you ask?” Or “I’m not sure—can I help you with something?” This allows the person to state where they are & possibly indicate what need they are expressing. Generally they are aware of the reciprocal aspect of the conversation. Use WWYD? (What would you do—want to hear?)

A more helpful way of talking about people is to say ‘person living with dementia’. Terminology such a ‘demented’ is rather outdated and can be seen as negative and labelling. The DEEP network, a group of people living with dementia have published useful guidance online about language that may be of interest to you.

A difficult question but there is always an answer. I have found that distraction seems to work, in other words either start talking about some one or something different. Always keep a kind attitude , and a smile on your face , mention a 'cup of tea'talking about a holiday, or a wedding that you saw coming out of Church, if it's a lovely day a stroll around the garden, seeing the flowers and the birds, take some bread crumbs and bird seed with you .

Telling ' loving fibs' are always useful, no one would accept to
be reminded the person they are asking for has been dead for ages, keep a list of practical answers eg, Cutting the lawn , gardening, gone to the football match, Gone shopping, At the hair dressers etc, photographs are usefull.

My wife has rapid-progressing Alzheimer's Disease and by far the most frequent distress relates to wanting to go to see mum (deceased 2013) and dad (deceased 1987), or wondering why mum and dad haven't been to see her for ages. Apart from rare occasions when she is temporarily aware that they have deceased, I find myself having to tell her that they're fine and we'll go and visit them tomorrow. But that first lie, well meant as it is, often seems to lead to more lies to back up the first one and that leaves me feeling very uncomfortable. I could never lie to my wife before her diagnosis and it goes against the grain to do so now, even when it's done out of loving care.
If I could have two wishes granted (apart from the obvious wish for instant cure / reversal of the disease), they would be that my wife of 49 years would know who I am and who our daughters and grandson are and that she would be always aware that her mum and dad had passed on, but not be in distress about that.

My mum has Alzheimer’s and my dad, her husband of 67 years died earlier this year, I think lying is a very negative term to use, my mum realises he has died but thinks it was a long time ago We don’t correct her nor do we insist on the whole truth a lot of the time, I think the right approach with mum is whatever causes the least distress.

My mum asked me, 'Do you suppose I'll ever get better? She was quite late stage by that point but had previously broken her hip so I paused to think and then replied, 'Well you're already a lot better than you were when you were in hospital aren't you?' She was happy with that answer. Another time she said, 'I need to be honest (she was very close to tears) with you Carla, half the time I haven't got a bloody clue what I'm doing. Do you think I'm going mad?' I replied, 'I don't know what I'm doing half the time either so I wouldn't worry about it too much!' She really laughed at that and it seemed to make her happy. The harsh truth would have destroyed her. I used distraction when she got upset about things as eventually I couldn't lift her mood but if I suddenly said, 'Wow, look at that!' pointing to something in the garden, she'd snap back and ask me what I was looking at. There's usually a way around things when you know somebody well and it's far kinder to find what works for them, usually without telling outright lies

Mum had dementia and white lies were always helpful when she was distressed. "When am I going home" was answered by 'after the doctors see you in the morning'. It calmed her and helped for another day.
My husband has vascular dementia but he hasn't reached this stage but at least I'm aware of what is to come.

After 55 years married bliss my wife & I are ageing & obvious signs of dementia are occurring, with me becoming something of a carer. Numerous NHS referrals to specialists have produced no feedback & my only solace to date has been the literature provided by the Alzheimer's Society. Despite being a former H.R. manager, I find the ongoing situation very taxing indeed.

I live with my partner who has dementia.
We are very happy together but his daughters who have power of attorney want to take him off without me. They don't like me and the one has always wanted to split us up. They want to put him in care but I feel this will upset him to be taken away from me. We love each other but they don't seem to realise this.
I look after him really well and there are no complaints off social security. I cry and cry. What can I do? His daughters really hate me.

Hi Josephine, I'm very sorry to hear about that. If you call our Helpline one of our advisers would be glad to discuss things with you and offer advice.
Our Helpline is open Monday to Wednesday (9am-8pm), Thursday to Friday (9am–5pm) and Saturday to Sunday (10am-4pm), and can be reached on 0300 222 11 22.
Thank you

Bless you Josephine; hard enough as it is. I look after my husband with Alzheimers - his sons haven't offered to take him off me yet! Don' think they will. Thinking of you, it is very hard. Hang in there x

This article would have been ideal when my now 94 years old mum first developed this cruel, insidious demeaning disease.

My wife who’ll be 93 in just over three weeks had additionally a stroke making her wholly dependent on the careers for everything except she can to some extent use a fork and knife. Her memory is gone but she still recognises relatives and friends when she sees them. I avoid telling lies and try to go along with her feelings. She used to be an active person always on the go. The demands she put on herself created stress of which she is free now and has become like a child delighting and responding positively to the careers - if they smile. But she tends to reject them if they don’t. So I make sure especially when she’s going to bed to tell her career to smile and joke. She then she gets involved with the career and forgets me and I can leave without distressing her. Little things like that can completely change things and bring back the joys of childhood back

Thank you all - I have had problems telling lies to my wife, but the comments here have helped a lot. One has to lie to avoid distress, but it is not easy.

I have found this 'piece' wholly encouraging and quite beautiful. Some of we humans do have to cope with intense feelings. Just to love someone with Alzheimer's sometimes isn't quite adequate. I'm therefore grateful for some of the very practical remarks. I use 'loving' lies - because they often help my wife. Long may you work continue. And the government WAKE UP!

It is so hard now to find out about pain or toilet needs as it becomes impossible to ask questions as the question is forgotten before my Darling can be respond. I can only hope she is pain free.

I never lied to my mother, I just joined her in her time and place at the time she was living it.
to try and correct her or tell her something else just sent a signal that all was not well and made her anxious which would lead to other problems,
It is there nightmare that they can never wake up from, so just go with their flow and try to make that moment in time a happy one.

When my wife pat ask for her mum or dad I do tell her the truth but also add that they would both be over 100 years old if they had lived
This she accepts

My wife is currently in hospital for meds review, she has been diagnosed with dementia. She can be either loving or hateful. She has had memory loss for some years after a stroke which we coped with well, but this is now a new development and is getting worse while in hospital, they seem to be adding different medications to her list each day without success or removal of those unsuccessful. Has anyone knowledge of Gabapentin use other than the Mayo clinic information and is anyone's loved one using it and if so at what amount in dose and times at hourly intervals, please answer soon I'm crying inside we've have been married over 55 years and seeing her like this is destroying me also.

my uncle was on this for pain relief after other medication didn't work

My mother is on this medication. Is there something wrong with it.

My husband was prescribed this medication for the dreadful pain he had in his back because of a trapped nerve, which finally was released through surgery. He continued for some weeks more. The medication made him very sleepy and his memory was worse. He was diagnosed with Alzheimers some weeks later, but we had been aware of MCI for two years . When he stopped Gabapentine his memory and awareness improved amazingly.

Little white lies - when someone is in a care home and asks to go home say there are no buses/ trains until tomorrow. When they ask to go home they have no idea where that is.

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